Aortography revealed bilateral renal artery stenosis in a patient with hypertension, diabetes mellitus, normal serum electrolyte levels, normal excretion of hydroxycorticosteroids, and increased excretion of aldosterone. Following an attempt at surgical correction of the stenosis, the patient died of a myocardial infarction. The autopsy revealed two adrenal adenomas which were morphologically indistinguishable from aldosterone-producing tumors. Therefore, the patient's hypertension would most likely not have been cured by correction of the renovascular lesions alone. Because concurrence of primary aldosteronism and renal artery stenosis is probably not rare, it is suggested that patients with renal artery stenosis be explored for adrenal adenomas prior to correction of the stenosis.
Bloch HS. Hypertension, Bilateral Renal Artery Stenosis, Adrenocortical Adenomas, and Normal Serum Electrolyte Levels. JAMA. 1966;196(7):622–624. doi:10.1001/jama.1966.03100200062019